title: Association of a prothrombotic state with left-ventricular diastolic dysfunction in hypertension: a tissue-Doppler imaging study.
abstract: OBJECTIVE
  In hypertensive patients the propensity to develop organ damage is under the influence of several factors, including the existence of a prothrombotic state. We tested the hypothesis that an activated hemostatic system is associated with left-ventricular diastolic dysfunction as assessed by tissue-Doppler imaging (TDI).
  
  
  METHODS
  In 198 patients with untreated essential hypertension free of clinically relevant cardiovascular complications, we measured plasma levels of fibrinogen, prothrombin fragment 1 + 2, D-dimer, plasminogen activator inhibitor-1, and tissue plasminogen activator, and performed conventional echocardiography and TDI.
  
  
  RESULTS
  Left-ventricular diastolic dysfunction was detected in 61 patients (31%) by conventional echocardiography and in 105 patients (53%) by TDI, 39% of whom had left-ventricular hypertrophy. Left-ventricular hypertrophy was associated with increased plasma fibrinogen and prothrombin fragment 1 + 2 levels. Patients with diastolic dysfunction at TDI were older and had greater BMI, SBP, left-ventricular mass index, and plasma fibrinogen and D-dimer levels than patients with normal diastolic function. Variables of diastolic function measured both at conventional echocardiography and TDI were significantly related with age, BMI, left-ventricular mass index, and plasma fibrinogen, D-dimer, and prothrombin fragment 1 + 2. Multivariate regression analysis showed that diastolic variables obtained at TDI were related to plasma fibrinogen levels independent of covariates.
  
  
  CONCLUSIONS
  Elevated plasma levels of fibrinogen and a prothrombotic state are associated with the presence of left-ventricular diastolic dysfunction in hypertensive patients with no evidence of ischemic heart disease and might increase the risk of diastolic heart failure.
authors.affiliation: Hypertension Unit, Internal Medicine, Department of Experimental and Clinical Medical Science, University of Udine, Udine, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Catena
authors.forename: GianLuca
authors.initials: G
authors.lastname: Colussi
authors.forename: Stefania
authors.initials: S
authors.lastname: Fedrizzi
authors.forename: Leonardo A
authors.initials: LA
authors.lastname: Sechi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation; D002318:Cardiovascular Diseases; D003430:Cross-Sectional Studies; D003971:Diastole; D015150:Echocardiography, Doppler; D000075222:Essential Hypertension; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D006333:Heart Failure; D006487:Hemostasis; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011516:Prothrombin / Q000378:metabolism; D012307:Risk Factors; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010959:Tissue Plasminogen Activator / Q000097:blood; D055815:Young Adult
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D; D011516:Prothrombin; D005340:Fibrinogen; D010959:Tissue Plasminogen Activator